{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T01:15:06Z","timestamp":1783300506667,"version":"3.54.6"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":62,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Capital\u2019s Funds for the Health Improvement and Research","award":["2024-1-2181"],"award-info":[{"award-number":["2024-1-2181"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-026-51936-7","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T16:36:10Z","timestamp":1777998970000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Organ failure-based clinical classification at onset of acute-on-chronic liver failure: a prospective multicenter cohort study"],"prefix":"10.1038","volume":"16","author":[{"given":"Manman","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenling","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanrong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaibin","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongping","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaojie","family":"Xin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoli","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaogang","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"issue":"Suppl 1","key":"51936_CR1","doi-asserted-by":"publisher","first-page":"S27","DOI":"10.1016\/j.jhep.2020.11.047","volume":"75","author":"R Moreau","year":"2021","unstructured":"Moreau, R. et al. Acute-on-chronic liver failure: A distinct clinical syndrome. J. Hepatol. 75(Suppl 1), S27-s35 (2021).","journal-title":"J. Hepatol."},{"key":"51936_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12072-024-10773-4","volume":"19","author":"A Choudhury","year":"2025","unstructured":"Choudhury, A. et al. Acute-on-chronic liver failure (ACLF): the \u2018Kyoto Consensus\u2019-steps from Asia. Hepatol. Int. 19, 1\u201369 (2025).","journal-title":"Hepatol. Int."},{"key":"51936_CR3","first-page":"18","volume":"27","author":"Chinese Medical Association","year":"2019","unstructured":"Chinese Medical Association. Diagnostic and treatment guidelines for liver failure (2018 version). Zhonghua Gan Zang Bing Za Zhi 27, 18\u201326 (2019).","journal-title":"Zhonghua Gan Zang Bing Za Zhi"},{"key":"51936_CR4","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1016\/j.jhep.2014.06.012","volume":"61","author":"R Jalan","year":"2014","unstructured":"Jalan, R. et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J. Hepatol. 61, 1038\u201347 (2014).","journal-title":"J. Hepatol."},{"key":"51936_CR5","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/j.jhep.2023.04.021","volume":"79","author":"EASL Clinical Practice Guidelines","year":"2023","unstructured":"EASL Clinical Practice Guidelines. On acute-on-chronic liver failure. J. Hepatol. 79, 461\u2013491 (2023).","journal-title":"J. Hepatol."},{"key":"51936_CR6","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1002\/hep.27077","volume":"60","author":"JS Bajaj","year":"2014","unstructured":"Bajaj, J. S. et al. Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures. Hepatology 60, 250\u20136 (2014).","journal-title":"Hepatology"},{"key":"51936_CR7","doi-asserted-by":"publisher","first-page":"2181","DOI":"10.1136\/gutjnl-2017-314641","volume":"67","author":"T Wu","year":"2018","unstructured":"Wu, T. et al. Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure. Gut 67, 2181\u20132191 (2018).","journal-title":"Gut"},{"key":"51936_CR8","doi-asserted-by":"publisher","first-page":"225","DOI":"10.14309\/ajg.0000000000001595","volume":"117","author":"JS Bajaj","year":"2022","unstructured":"Bajaj, J. S. et al. Acute-on-Chronic Liver Failure Clinical Guidelines. Am. J. Gastroenterol. 117, 225\u2013252 (2022).","journal-title":"Am. J. Gastroenterol."},{"key":"51936_CR9","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1097\/HEP.0000000000000671","volume":"79","author":"CJ Karvellas","year":"2024","unstructured":"Karvellas, C. J. et al. AASLD practice guidance on acute-on-chronic liver failure and the management of critically ill patients with cirrhosis. Hepatology 79, 1463\u20131502 (2024).","journal-title":"Hepatology"},{"key":"51936_CR10","unstructured":"Aggarwal, A. et al. Definitions, Etiologies, and Outcomes of Acute on Chronic Liver Failure: A Systematic Review and Meta-analysis (Clin Gastroenterol Hepatol, 2024)."},{"key":"51936_CR11","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.1053\/j.gastro.2013.02.042","volume":"144","author":"R Moreau","year":"2013","unstructured":"Moreau, R. et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 144, 1426\u20131437 (2013).","journal-title":"Gastroenterology"},{"key":"51936_CR12","doi-asserted-by":"publisher","first-page":"2521","DOI":"10.1097\/CM9.0000000000003289","volume":"137","author":"M Xu","year":"2024","unstructured":"Xu, M. & Chen, Y. New perspectives in the definition and classification of acute-on-chronic liver failure. Chin Med J (Engl) 137, 2521\u20132525 (2024).","journal-title":"Chin Med J (Engl)"},{"key":"51936_CR13","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.750061","volume":"8","author":"M Xu","year":"2021","unstructured":"Xu, M. et al. Acute-on-chronic liver failure defined by Asian Pacific Association for the Study of the Liver should include decompensated cirrhosis. Front. Med. 8, 750061 (2021).","journal-title":"Front. Med."},{"key":"51936_CR14","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1136\/gutjnl-2020-322161","volume":"71","author":"G Mezzano","year":"2022","unstructured":"Mezzano, G. et al. Global burden of disease: acute-on-chronic liver failure, a systematic review and meta-analysis. Gut 71, 148\u2013155 (2022).","journal-title":"Gut"},{"key":"51936_CR15","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1016\/j.jhep.2021.05.026","volume":"75","author":"J Li","year":"2021","unstructured":"Li, J. et al. Development and validation of a new prognostic score for Hepatitis B virus-related acute-on-chronic liver failure. J. Hepatol. 75, 1104\u20131115 (2021).","journal-title":"J. Hepatol."},{"key":"51936_CR16","doi-asserted-by":"publisher","first-page":"S131","DOI":"10.1016\/j.jhep.2014.11.045","volume":"62","author":"V Arroyo","year":"2015","unstructured":"Arroyo, V. et al. Acute-on-chronic liver failure: A new syndrome that will re-classify cirrhosis. J. Hepatol. 62, S131-43 (2015).","journal-title":"J. Hepatol."},{"key":"51936_CR17","doi-asserted-by":"publisher","first-page":"1425","DOI":"10.1016\/j.jhep.2020.06.005","volume":"73","author":"R Hernaez","year":"2020","unstructured":"Hernaez, R. et al. Model for End-Stage Liver Disease-Sodium underestimates 90-day mortality risk in patients with acute-on-chronic liver failure. J. Hepatol. 73, 1425\u20131433 (2020).","journal-title":"J. Hepatol."},{"key":"51936_CR18","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1111\/apt.15988","volume":"52","author":"V Sundaram","year":"2020","unstructured":"Sundaram, V. et al. Patients with severe acute-on-chronic liver failure are disadvantaged by model for end-stage liver disease-based organ allocation policy. Aliment. Pharmacol. Ther. 52, 1204\u20131213 (2020).","journal-title":"Aliment. Pharmacol. Ther."},{"key":"51936_CR19","doi-asserted-by":"publisher","first-page":"399","DOI":"10.17235\/reed.2017.4701\/2016","volume":"109","author":"R Barosa","year":"2017","unstructured":"Barosa, R. et al. CLIF-C ACLF score is a better mortality predictor than MELD, MELD-Na and CTP in patients with acute on chronic liver failure admitted to the ward. Rev. Esp. Enferm. Dig. 109, 399\u2013405 (2017).","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"51936_CR20","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.1016\/j.jhep.2020.06.030","volume":"73","author":"R Jalan","year":"2020","unstructured":"Jalan, R. & Arroyo, V. Organ allocation for patients with acute-on-chronic liver failure: Time to look beyond MELD-sodium?. J. Hepatol. 73, 1316\u20131318 (2020).","journal-title":"J. Hepatol."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-51936-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-51936-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-51936-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:39:57Z","timestamp":1783298397000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-51936-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["51936"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-51936-7","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]},"assertion":[{"value":"5 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"20702"}}